title: High-flow extracranial-to-intracranial excimer laser-assisted nonocclusive anastomosis bypass for symptomatic carotid artery occlusion.
abstract: BACKGROUND
  A high-flow bypass is theoretically more effective than a conventional low-flow bypass in preventing strokes in patients with symptomatic carotid artery occlusion and a compromised hemodynamic state of the brain.
  
  
  OBJECTIVE
  To study the results of excimer laser-assisted nonocclusive anastomosis (ELANA) high-flow extracranial-to-intracranial (EC-IC) bypass surgery in these patients.
  
  
  METHODS
  Between August 1998 and May 2008, 24 patients underwent ELANA EC-IC bypass surgery because of transient ischemic attacks or minor ischemic stroke associated with carotid artery occlusion. We retrospectively collected information. Follow-up data were updated by structured telephone interviews between May and September 2008.
  
  
  RESULTS
  In all patients, the ELANA EC-IC bypass was patent at the end of surgery with a mean flow of 106 ± 41 mL/min. Within 30 days after the operation, 22 patients (92%) had no major complication, whereas 2 patients (8%) had a fatal intracerebral hemorrhage. During follow-up of a mean 4.4 ± 2.4 years, the bypass remained patent in 18 of the 22 surviving patients (82%) with a mean flow of 141 ± 59 mL/min. All patients with a patent bypass remained free of transient ischemic attacks and ischemic stroke. In 4 patients, the bypass occluded, accompanied by ipsilateral transient ischemic attacks in 2 patients, ipsilateral ischemic stroke in 1 patient, and contralateral ischemic stroke in another patient.
  
  
  CONCLUSIONS
  ELANA EC-IC bypass surgery in patients with carotid artery occlusion is technically feasible and results in cessation of ongoing transient ischemic attacks and minor ischemic strokes, but carries a risk of postoperative hemorrhage.
authors.affiliation: Department of Neurosurgery, University Medical Center Utrecht, Rudolf Magnus Institute of Neuroscience, Utrecht, The Netherlands. T.P.C.vandoormaal@umcutrecht.nl
authors.forename: Tristan P C
authors.initials: TP
authors.lastname: van Doormaal
authors.forename: Catharina J M
authors.initials: CJ
authors.lastname: Klijn
authors.forename: Perry T C
authors.initials: PT
authors.lastname: van Doormaal
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: Luca
authors.initials: L
authors.lastname: Regli
authors.forename: Cornelius A F
authors.initials: CA
authors.lastname: Tulleken
authors.forename: Albert
authors.initials: A
authors.lastname: van der Zwan
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000601:surgery; D002340:Carotid Artery Diseases / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000453:epidemiology; D002548:Cerebral Revascularization / Q000009:adverse effects* / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000517:prevention & control / Q000601:surgery; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012501:Saphenous Vein / Q000637:transplantation; D020521:Stroke / Q000209:etiology / Q000517:prevention & control / Q000601:surgery